Vice President Mike Pence’s tie-breaking vote in the Senate was 10 years in the making.

Thursday’s vote is one battle in the war Pence has waged on Planned Parenthood throughout his political career. As a representative, Pence proposed the same bill that prohibited federal funding to family planning facilities that perform or provide funds to abortion providers three times. During his time as Indiana’s 50th governor Pence signed every abortion restriction bill that passed his desk including the controversial House Bill 1337.

This week, the Senate voted to repeal former President Barack Obama’s last-ditch effort to protect state funding for family planning facilities, which stated that family planning providers could not be discriminated against for reasons other than the quality of care they offer.

This vote was separate from the hot button issue of defunding Planned Parenthood by blocking Medicaid reimbursements. The defunding proposal was tied to the GOP’s promise of repealing Obama’s health care law. The repeal of “Obamacare” did not happen last Friday.

Instead, this action gives states the right to deny public funding to Planned Parenthood and similar health clinics. It now awaits President Trump’s signature.

This type of action is one Betty Cockrum, CEO and president of Planned Parenthood of Indiana and Kentucky, has been anticipating.

“It’s been troubling that he’s been the kind of politician that he’s been in Indiana — both in Congress and the last four years as our governor — and for him to now ascend to the national platform as the second-highest-ranking elected official, it’s just a huge concern,” Cockrum said in a December interview with the Indiana Daily Student.

A direct attack on family planning and abortion providers, along with the still-pending Supreme Court nomination of Neil Gorsuch, is what kept Cockrum hiding in her bed after the election.

“He needs to get out of our doctor’s offices,” Cockrum said of Pence in December. “He didn’t get a medical license when he was sworn in as governor. The legislators don’t get a medical license when they’re sworn in to become our lawmakers here in Indiana.”

The threat of Trump’s legacy and his administration’s conservative agenda is also what keeps her coming into back into the office every day. There’s work to be done, one day at a time.

“The immediate issue is it’s going to play out in the wrong direction for a pretty long time,” Cockrum said in December.

The bill passed Thursday was sponsored by Sen. Joni Ernst, R-Iowa. It reached a 50-50 vote when Sen. Johnny Isakson, R-Georgia, returned to the Capitol after recovering from back surgery to cast his vote. The vote was kept open for an hour while the Senate waited for Isakson to arrive from the Reagan National Airport. Pence walked him to the Senate floor, according to CNN.

These proposed restrictions all fall under the umbrella of Title X, which has served as the only source of federal funding dedicated exclusively for family planning. Former Republican President Richard Nixon signed this into law in 1970 as a way to support low-income women.

Title X funds do not pay for abortion services. They are allocated to sexual and reproductive health care services such as contraceptives, sexually transmitted disease testing, cancer screenings, prenatal care and sex education.

Today, the network of providers under Title X serves more than 4 million low-income Americans. Among those patients, a third of them use Planned Parenthood as a health care provider.

“More than 30,000 Hoosiers depend on the Title X family planning program, and this political circus jeopardizes access to health care for real people.” Planned Parenthood said in a statement. “Too many people still face barriers to health care, especially young people, people of color, those who live in rural areas, and people with low incomes.”

Planned Parenthood clinics in Indiana receive money from Title IX, but those in Kentucky do not. The organization preemptively left Title IX and became self-sustainable before Kentucky Senate Bill 8 was passed which denied state funding to family planning facilities that performed or funded abortions. Indiana does not have a law in the books that prohibits state funding and the legislative session is now closed to new bills.

Title X aids primarily women of color or younger women. The Bloomington Planned Parenthood served 1,551 patients ages 20-24 in 2015. The majority of its patients were at or below the poverty line.

Ernst recently penned an op-ed in the Washington Examiner titled “Marking a new era committed to protecting our most vulnerable.” She and co-author Rep. Diane Black,R-Tennessee, promised further action.

“With a pro-life president in the White House and pro-life majorities in the House and Senate, we will continue to work together this year to undo the damage done by the Obama administration,” they said in the op-ed.

After the election Patti Stauffer, vice president of policy, strategy and compliance at Planned Parenthood of Indiana and Kentucky, also recognized the pro-life movement gaining momentum. Stauffer, who meets with legislators from both sides of the aisle, feared that the conservative agenda Trump is introducing would set the tone for reproductive health long after his presidency.

“There’s a whole lot of time for a whole lot of damage,” Stauffer said.

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